Energy Balance After Sodium–Glucose Cotransporter 2 Inhibition

OBJECTIVE

Sodium–glucose cotransporter 2 (SGLT2) inhibitors cause substantially less weight loss than expected from the energy excreted via glycosuria. Our aim was to analyze this phenomenon quantitatively.

RESEARCH DESIGN AND METHODS

Eighty-six patients with type 2 diabetes (HbA_1c 7.8 ± 0.8% [62 ± 9 mmol/mol], estimated glomerular filtration rate [eGFR] 89 ± 19 mL ⋅ min⁻¹ ⋅ 1.73 m⁻²) received empagliflozin (25 mg/day) for 90 weeks with frequent (n = 11) assessments of body weight, eGFR, and fasting plasma glucose (FPG). Time-dependent glucose filtration was calculated as the product of eGFR and FPG; time-dependent glycosuria was estimated from previous direct measurements. The relation of calorie-to-weight changes was estimated using a mathematical model of human energy metabolism that simulates the time course of weight change for a given change in calorie balance and calculates the corresponding energy intake changes.

RESULTS

At week 90, weight loss averaged −3.2 ± 4.2 kg (corresponding to a median calorie deficit of 51 kcal/day [interquartile range (IQR) 112]). However, the observed calorie loss through glycosuria (206 kcal/day [IQR 90]) was predicted to result in a weight loss of –11.3 ± 3.1 kg, assuming no compensatory changes in energy intake. Thus, patients lost only 29 ± 41% of the weight loss predicted by their glycosuria; the model indicated that this difference was accounted for by a 13% (IQR 12) increase in calorie intake (269 kcal/day [IQR 258]) coupled with a 2% (IQR 5) increase in daily energy expenditure (due to diet-induced thermogenesis). This increased calorie intake was inversely related to baseline BMI (partial r = −0.34, P < 0.01) and positively to baseline eGFR (partial r = 0.29, P < 0.01).

CONCLUSIONS

Chronic glycosuria elicits an adaptive increase in energy intake. Combining SGLT2 inhibition with caloric restriction is expected to be associated with major weight loss.     

早期营养支持对儿童重型颅脑外伤患者ICU治疗时间和预后影响的分析

目的：探讨开始营养支持和达到完全热量摄入的时间对儿童重型颅脑外伤（TBI）患者在ICU的治疗时间和预后的影响。方法对109例入住ICU的儿童重型 TBI患者的资料进行回顾性分析。入院后开始营养支持,记录患者入IC U后的营养支持方式、开始时间和达到完全热量摄入的时间,统计分析其与患者IC U 治疗时间和预后的相关性。结果本组19例患者未开始营养支持前即死亡,余下的90例中入院后营养支持开始时间平均为（1．49＆#177;0．82）d;89例达到完全热量摄入的平均时间为（3．39＆#177;0．71）d ,在IC U的平均治疗时间为（2．09＆#177;1．01）d。本组出院时根据儿童脑功能分级量表评估,57．8％的患者恢复良好,33．3％的患者残疾,8．9％的患者死亡或昏迷状态。统计显示,入ICU后开始营养支持时间和达到完全热量摄入天数与ICU治疗天数呈正性相关（P＜0．01）,开始营养支持时间和达到完全热量摄入天数越短预后越好（P＜0．05）。结论早期营养支持可缩短儿童重型 TBI患者在IC U的治疗时间和改善预后。     

Dental and gastrointestinal changes as indicators of nutritional depletion in elderly inpatients

Objective The objective of this study was to identify the associations between the nutritional status of elderly patients and length of hospital stay and presence of dental and gastrointestinal changes. Casuistic and method This cross‐sectional study analyzed anthropometric and food intake indicators, dental and gastrointestinal changes and length of hospital stay of 441 elderly patients of both genders. The Pearson's correlation coefficient was used to verify the correlation between the nutritional status of the elderly patients and length of hospital stay and presence of dental and gastrointestinal changes. The significance level was set at P < 0.05. Results Dietary and anthropometric variables as well as length of hospital stay were similar for patients with and without dental changes. Patients with gastrointestinal changes consumed less energy (P < 0.05) than patients without gastrointestinal changes. Length of hospital stay was inversely correlated with body mass index (r = ?0.15; P < 0.05); arm circumference was inversely correlated with presence of dental changes (r = ?0.12; P < 0.05) and mid‐arm muscle circumference was inversely correlated with gastrointestinal changes (r = ?0.12; P < 0.05). Conclusion Dental and gastrointestinal changes are important indicators of nutritional depletion and dietary intake of inpatients.     

Upright body position and weight loss improve respiratory mechanics and daytime oxygenation in obese patients with obstructive sleep apnoea

To determine whether upright body position and weight loss would improve daytime gas exchange in moderately obese patients with obstructive sleep apnoea (OSAS), 13 patients with mild or moderate OSAS were studied before and after weight loss. Pulmonary function tests, arterial blood gases and respiratory gas analysis were measured prior to and after a very low calorie diet (VLCD) period of six weeks. Arterial blood gases were measured in supine and standing positions and closing volume in supine and sitting positions before and after weight loss. In the upright position, there was a significant increase in PaO₂ (P<0·005) accompanied by a significant decrease in alveolar–arterial PO₂ difference (P<0·005) and closing volume (P<0·05). The median weight loss was 11 kg (range 5–18). The number of desaturation episodes (four percentage units or more per hour during sleep) (ODI₄) decreased (P<0·01) after weight loss. The change in PaO₂ with weight loss correlated with the decrease in ODI₄ (r=0·73, P<0·01). The increase in expiratory reserve volume (ERV) was closely related to the amount of weight lost (r=0·895, P<0·01). The results indicate that weight loss and upright body position improved daytime respiratory mechanics and gas exchange in obese patients with OSAS. The findings suggest that obesity plays an important role in the pathogenesis of daytime gas exchange disturbances in obese OSAS patients. The adoption of a more upright sleep posture might improve nocturnal oxygenation in obese patients with OSAS.     

Does nutritional intervention for patients with hip fractures reduce postoperative complications and improve rehabilitation?

Aims and objectives. The aims were to investigate whether there were any differences between patients receiving nutritional intervention preoperatively and over five days postoperatively and patients who did not, in terms of postoperative complications, rehabilitation, length of stay and food and liquid intake. Background. Patients with hip fractures are often malnourished at admission to hospital and they typically do not receive the energy and calories needed postoperatively. Design. The design was a quasi‐experimental, pre‐ and post‐test comparison group design without random group assignment. Methods. One hundred patients with hip fractures were consecutively included. The control group (n = 50) received regular nutritional support. The intervention group (n = 50) received nutrition according to nutritional guidelines. The outcome measures used were risk of pressure ulcer, pressure ulcers, weight, nosocomial infections, cognitive ability, walking assistance and functional ability, collected preoperatively and five days postoperatively. Each patient’s nutrient and liquid intake were assessed daily for five days postoperatively. Results. Significantly fewer (p = 0·043) patients in the intervention group (18%) had pressure ulcers five days postoperatively compared with the control group (36%). Nutrient and liquid intake was significantly higher (p < 0·001) in the intervention group. Median length of stay decreased from nine to seven days (p = 0·137), as did nosocomial infections, from 18–8·7% (p = 0·137). Conclusion. Patients with hip fractures receiving nutrition according to nutritional guidelines developed fewer pressure ulcers. This is invaluable to patients’ quality of life and a major economic saving for society. Relevance to clinical practice. Great benefits can be gained for the patients through modest efforts by nurses and physicians such as nutritional intervention.     

Symptoms and weight loss in patients with gastrointestinal and lung cancer at presentation

Introduction Weight loss is an independent prognostic factor for decreased survival in cancer patients. The effectiveness of treatment is impaired in patients with weight loss. The aetiology of this weight loss is complex and poorly characterised. Decreased calorie intake may be important. The reasons for decreased intake are unknown. Aims and methods To determine in adult patients with cancer, who had not started chemotherapy or radiotherapy, the prevalence of symptoms which carry a risk to nutritional status and how these relate to weight loss, tumour burden and primary tumour site. New patients referred for treatment of any form of gastrointestinal (GI) cancer, non-small cell lung cancer or lung mesothelioma completed a validated questionnaire recording symptoms contributing to weight loss (Patient-generated Subjective Global Assessment—PG-SGA). In a subset of patients without metastatic disease, computed tomography scans were assessed to determine tumour burden. Results Between August and October 2004, 122 patients with GI and 29 with lung cancers were recruited. There were 48% of GI and 28% of lung cancer patients who had lost weight. Sixty-two percent of the patients had one or more symptoms at presentation. The frequency of symptoms varied according to the site of disease. The most common symptom at all tumour sites was loss of appetite (38%). There was a weak but significant correlation between the number of symptoms and amount of weight loss (r=0.347). Patients reporting a reduced food intake had more symptoms than patients who had not lost weight. Tumour burden did not correlate with weight loss. Conclusion The symptoms in cancer patients occur across different types of primary tumours, may affect food intake and have a part in causing weight loss. More information on the role of symptom management in improving nutritional status is needed.     

Physical capacities assessment in critically ill patients: An exploratory study

BackgroundThe severity of muscle weakness after critical illness is very heterogeneous. To identify those patients who may maximally benefit from early exercises would be highly valuable. This implies an assessment of physical capacities, comprised at least of strength measurement and functional tests.ObjectivesThe objective of this study was to investigate the relationship between muscle strength and functional tests in an intensive care unit (ICU) setting.MethodsAdults with ICU length of stay ≥2 days were included. Handgrip strength (HG) and maximal isometric quadriceps strength (QS) were assessed using standardised protocols as soon as patients were alert and able to obey commands. At the same time, their maximal level of mobilisation capabilities and their autonomy were assessed using ICU Mobility Scale (ICU-MS) and Barthel Index, respectively.ResultsNinety-three patients with a median age of 64 [57–71.5] years, body mass index of 26.4 [23.4–29.6] kg/m², and Simplified Acute Physiology Score II of 33 [27.7–41] were included. Absolute and relative QS were, respectively, 146.7 [108.5–196.6] N and 1.87 [1.43–2.51] N/kg. HG was 22 [16–31] kg. The ICU-MS score was 4 [1–5]. A significant positive correlation was observed between HG and absolute QS (r_s = 0.695, p < 0.001) and between HG and relative QS (r_s = 0.428, p < 0.001). The ICU-MS score correlated with HG, with a weak positive relationship (r_s = 0.215, p = 0.039), but not with QS. The ICU-MS score did not statistically differ between the weakest and strongest patients for absolute or relative QS, but was lower in patients with the lowest HG values (p = 0.01). A weak positive correlation was observed between the Barthel Index and muscle strengths (maximum r_s = 0.414, p < 0.001).ConclusionsThe present results suggest that, during ICU stay, there is no strong association between muscle strength and functional test such as the ICU-MS or Barthel Index. Muscle dynamometry and functional tests are probably complementary tools for physical capacities quantification.     

Six‐minute walking test and the assessment of cardiorespiratory responses during weight‐loss programmes in obese children

Purpose. We assessed the exercise tolerance and cardiorespiratory responses during 2‐month weight‐loss programmes using the 6‐minute walking test (6MWT) in obese children. Methods. Twenty‐eight male obese children were randomly assigned to either a control group (C), an energy restriction group (R), an exercise training at maximum lipid‐oxidation (LIPOXmax) group (E), or an energy restriction/training group (RE). The body composition, the submaximal incremental cycling exercise, and the 6MWT were performed before and after the 2‐month programme. Results. After the programme, RE group showed a significant improvement of body composition (body weight reduced by 6.3 ± 1.5 kg, p < 0.01), and an increase of 6‐minute walking distance (6MWD) (+13.7%, p < 0.01). Similarly, maximum oxygen uptake calculated according to the American College of Science Medicine guideline (VO_2maxACSM) and VO_2max predicted from 6MWD were respectively higher (+12.9% and +10.0%, p < 0.01) than the R or E groups. Bland‐Altman analysis highlighted an agreement of these two methods of VO_2max measurement. Moreover, in all participants the 6MWD was significantly correlated with VO_2maxACSM and LIPOXmax (r = 0.77, p < 0.001 and r = 0.67, p < 0.01; respectively) before the programme as well as their changes in percentage over the programme (r = 0.85 and r = 0.86, p < 0.0001; respectively). Conclusions. We concluded that a 2‐month weight‐loss programme including energy restriction and exercise training targeted at LIPOXmax improved body composition and cardiorespiratory tolerance in obese children. Furthermore, the 6MWT could be considered as a useful and reliable tool for the assessment and the follow‐up of cardiorespiratory responses during weight‐loss programme in obese children. Copyright © 2010 John Wiley & Sons, Ltd.     

The effect of caloric of food on energy intake and body weight in tumor-bearing rats

Anorexia and weigt loss are major problems for cancer patients and are associated with increased cancer morbidity and mortality. The current clinical approach is to encourage high calorie food intake. In the present study, we used an animal model of tumor-induced anorexia to evaluate the effect of feeding a high caloric diet on food and caloric intake and body weight of tumor-bearing rats. Tumor-bearing rats fed a diet containing 4.7 kcal/g reduced the amount of food they ate to equal the caloric intake of rats fed a diet containing 3.7 kcal/g. Body weight and tumor growth were not affected by the diet intervention. These data suggest that energy intake is regulated in tumor-bearing rats as it is in healthy animals, albeit at a lower level. These data have implications for further study of the effects of nutritional supplements on food intake and nutritional status of cancer patients. ©1995 John Wiley & Sons, Inc.     

Effects of intradialytic parenteral nutrition in chronic haemodialysis patients with malnutrition: a pilot study

BACKGROUND AND AIMS: Protein and calorie malnutrition is frequently observed in chronic haemodialysis (HD) patients. Recently it has been suggested that intradialytic nutritional support with amino acids may improve nutritional status and increase immunocompetence. The aim of this study was to evaluate the effects of intradialytic infusion of amino acids, lipids and glucose on body composition and other parameters of nutritional status in patients undergoing HD. METHODS: Seven patients with a mean age of 77 +/- 6 years (range, 60-86 years), a mean BMI of 20.1 +/- 2.8 (range, 16.1-24.4) and clinical signs of malnutrition participated in the study (mean time on HD, 51 +/- 36 months). HD was performed 12 hours per week with bicarbonate as a buffer and a polysulfon capillary dialyzer (F-60). During the 3-month period of intervention the patients received an intradialytic parenteral solution during the regular scheduled dialysis treatment, containing amino acids (12 g s/h), a glucose 15% solution (37.5 g/h) and a fat emulsion (12.5 g/h). RESULTS: (mean +/- SEM) Total calorie intake increased from 1550 +/- 63 to 2255 +/- 114 (kcal/24 h) p < 0.01, during the intervention period and body weight increased from 49.9 +/- 5.9 to 51.9 +/- 5.7 kg (p < 0.005). Fat mass and lean body mass (bioelectrical impedance analysis, BIA) increased from 13.2 +/- 2.6 to 14.2 +/- 2.6 (p < 0.02) and from 36.9 +/- 3.2 to 37.9 +/- 3.2 kg (p < 0.003), respectively. Plasma concentrations of albumin, total protein, transferrin, leptin IGF-I, IGFBP-3 and the protein catabolic rate remained unchanged. CONCLUSIONS: Supplementary intravenous intradialytic nutrition in chronic HD patients with malnutrition increased total body weight by effecting equivalent increases in lean body and fat masses.     

A 24‐week randomised controlled trial comparing usual care and metabolic‐based diet plans in obese adults

Background: Usual care (UC) practice for weight management often includes providing standardised, ad libitum, low‐calorie nutrition plans. However, weight loss using such plans appears comparable with metabolic‐based diet (MD) plans that are closer to resting energy expenditure (REE) level. In addition, MD plans are approximately 250–750 kcal/day higher in caloric values compared with UC plans. Therefore, the purpose of this study was to compare weight loss and eating behaviour differences between UC and MD plans. Methods: Seventy‐four obese (30.0–51.7 kg/m²) adults (21–67 years) voluntarily participated in a 24‐week randomised study. UC men and women received a fixed, ad libitum, 1600 and 1200 kcal/day nutrient plan, respectively. MD participants received an individualised treatment plan based from measured REE. Bodyweight and eating behaviours (i.e. intake, restraint and uncontrolled eating) were assessed over time. Results: Intent‐to‐treat analysis indicated no significant difference in weight loss (UC: ?5.7 ± 6.3% vs. MD: ?5.3 ± 7.1% p = 0.67) between groups over time. There was no difference in daily energy intake (UC: 2490 ± 576 kcal/day vs. MD: 2525 ± 475 kcal/day) at 24 weeks between groups. Both groups experienced a significant improvement (p < 0.05) in eating dietary restraint and uncontrolled eating yet there was no difference between groups. Conclusion: From this study, UC calorie plans do not generate more weight loss or improve eating behaviours in comparison with MD calorie plans. As treatment effects are comparable, clinicians can select UC or MD plan options based on clinician and patient preference.     

Nutritional behaviour and quality of life during oncological polychemotherapy: Results of a prospective study on the efficacy of oral nutrition therapy in patients with acute leukaemia

A total of 29 patients with acute leukaemia were prospectively randomized before starting cytostatic treatment to be nourished either with intensified oral nutrition (intervention group) or ad libitum nutritional intake during the whole tumour therapy (median 22 weeks). All received menus of free choice (daily offer of 1.0-2.0 g protein, 30-50 kcal kg-1 body weight (BW)). Beyond this, intervention patients received nutrition education, daily visits by the dietician and record of food intake, as well as a weekly assessment of subjective well-being (linear analogue self assessment 'LASA'). From the LASA items, the factors: 'malaise', 'psychological distress', 'therapy side-effects' were extracted by principal component analysis, and correlated to nutrient intake and nutritional status. At the end of antineoplastic induction therapy, after continuous hospitalization of 10 weeks (median), 31.3% of the controls had regained their initial nutritional status, and 68.8% of the intervention group. Mean daily energy intake was 23.2 kcal kg-1 BW during weeks with weight loss (constant weight: 30.9, weight gain: 39.3 kcal kg-1 BW). Nutritional behaviour correlated with subjective well-being, low intake with complaints of tumour treatment side effects and weight loss with malaise.     

Effect of initial calorie intake via enteral nutrition in critical illness: a meta-analysis of randomised controlled trials

IntroductionGuidelines support the use of enteral nutrition to improve clinical outcomes in critical illness; however, the optimal calorie and protein intake remains unclear. The purpose of this meta-analysis was to quantitatively analyze randomised controlled trials with regard to clinical outcomes related to varying calorie and protein administration in critically ill adult patients.MethodWe searched Medline, EMBASE, and Cochrane databases to identify randomised controlled trials that compared the effects of initially different calorie and protein intake in critical illness. The risk ratio (RR) and weighted mean difference with 95% confidence intervals (CI) were calculated using random-effects models. The primary endpoint was mortality; secondary endpoints included infection, pneumonia, gastrointestinal intolerance, hospital and intensive care unit lengths of stay, and mechanical ventilation days.ResultsIn the eight randomised controlled trials that enrolled 1,895 patients there was no statistical difference between the low-energy and high-energy groups in mortality (RR, 0.90; 95% CI, 0.71 to 1.15; P = 0.40), infection (RR, 1.09; 95% CI, 0.92 to 1.29; P = 0.32), or the risk of gastrointestinal intolerance (RR, 0.84; 95% CI, 0.59 to 1.19; P = 0.33). In subgroup analysis, the low-energy subgroup, fed 33.3 to 66.6% of goal energy, showed a lower mortality than the high-energy group (RR, 0.68; 95% CI, 0.51 to 0.92; P = 0.01). The improvements in mortality and gastrointestinal intolerance were absent when calorie intake was >66.6% of goal energy in the low-energy group. High-energy intake combined with high-protein intake reduced the infections (RR, 1.25; 95% CI, 1.04 to 1.52; P = 0.02); however, when the daily protein intake was similar in both groups, a high-energy intake did not decrease the infections. No statistical differences were observed in other secondary outcomes.ConclusionThis meta-analysis indicates that high-energy intake does not improve outcomes and may increase complications in critically ill patients who are not malnourished. Initial moderate nutrient intake (33.3 to 66.6% of goal energy), compared to high energy, may reduce mortality, and a higher protein intake combined with high energy (≥0.85 g/kg per day) may decrease the infection rate. However, the contribution of energy versus protein intake to outcomes remains unknown.

Electronic supplementary material

The online version of this article (doi:10.1186/s13054-015-0902-0) contains supplementary material, which is available to authorized users.     

Using Speed of Sound Imaging to Characterize Breast Density

A population of 165 women with negative mammographic screens also received an ultrasound tomography (UST) examination at the Karmanos Cancer Institute in Detroit, MI. Standard statistical techniques were employed to measure the associations between the various mammographic- and UST-related density measures and various participant characteristics such as age, weight and height. The mammographic percent density (MPD) was found to have similar strength associations with UST mean sound speed (Spearman coefficient, r_s = 0.722, p < 0.001) and UST median sound speed (r_s = 0.737, p < 0.001). Both were stronger than the associations between MPD with two separate measures of UST percent density, a k-means (r_s = 0.568, p < 0.001) or a threshold (r_s = 0.715, p < 0.001) measure. Segmentation of the UST sound speed images into dense and non-dense volumes showed weak to moderate associations with the mammographically equivalent measures. Relationships were found to be inversely and weakly associated between age and the UST mean sound speed (r_s = ?0.239, p = 0.002), UST median sound speed (r_s = ?0.226, p = 0.004) and MPD (r_s = ?0.204, p = 0.008). Relationships were found to be inversely and moderately associated between body mass index (BMI) and the UST mean sound speed (r_s = ?0.429, p < 0.001), UST median sound speed (r_s = ?0.447, p < 0.001) and MPD (r_s = ?0.489, p < 0.001). The results confirm and strengthen findings presented in previous work indicating that UST sound speed imaging yields viable markers of breast density in a manner consistent with mammography, the current clinical standard. These results lay the groundwork for further studies to assess the role of sound speed imaging in risk prediction.     

Multiple intubation attempts in the emergency department and in-hospital mortality: A retrospective observational study

ObjectivesMultiple intubation attempts in the Emergency Department (ED) have been associated with adverse events, but no study examined the influence of multiple intubation attempts on survival during hospitalization. Our aim was to compare one or more intubation attempts in the ED with risk of morbidity and mortality during hospitalization.MethodsWe conducted a single center retrospective analysis of all patients undergoing emergency intubation in the ED and then admission to the hospital, during September 2010 to April 2016. The primary exposure was multiple intubation attempts. The primary outcome was mortality during hospitalization after intubation in the ED.ResultsOf 181 patients, 63 (35%) required two or more attempts. We found no significant difference in mortality (p = 0.11), discharge from the hospital (p = 0.45), length of stay in hospital (p = 0.34), intensive care unit (ICU) (p = 0.32), ED (p = 0.81) or intubation period (p = 0.64), between one or more intubation attempts. After adjustment for the number of intubation trials, age, sex, intubation methods, first intubator training level and diagnostic category, use of medications during intubation was the only independent prognostic variable for hospital death (adjusted OR 0.21, 95%CI 0.1–0.45, p < 0.01). Number of trials to achieve successful intubation was not associated with discharge disposition (OR 0.77 95%CI 0.24–2.46, p = 0.66). Age (OR 0.95, 95%CI 0.93–0.98, p < 0.01) and brain injury as a diagnostic category (OR 0.15 95%CI 0.04–0.56, p < 0.01) were independent prognostic variables.ConclusionsWe found multiple intubation attempts were not associated with increased mortality and morbidity during hospitalization.     

Impact of apheresis automation on procedure quality and predictability of CD34+ cell yield

Success of peripheral blood stem cell (PBSC) collections depends on patient biological parameters and stable apheresis device performance. We investigated product quality and factors influencing main apheresis procedure outcomes including CD34⁺ collection efficiency (CE), product volume or platelet CE. We also assessed different CD34⁺ cell yield prediction algorithms. Autologous PBSC collections by Spectra Optia from myeloma and lymphoma patients were analyzed. Complete blood count (CBC) from patient preprocedure and from collected products were assessed. (1) Product yield was calculated, (2) Product CBC was correlated with patient preprocedure variables, and (3) Predictions of CD34⁺ yields based on (a) product CD34⁺ cell concentration in samples after two or four chamber flushes or (b) traditional CE2 benchmark, were compared. 62 procedures in 41 patients were analyzed. 84% of all procedures were run without operator intervention. Median CD34⁺ CE2 was 56.9% (48.8%‐65.2%) and quite stable irrespective of patient conditions, with minor influence from patient white blood cell (WBC) precounts (r_s = –.47; P < .001). Platelet loss correlated with WBC precount (r_s = .46; P < .001), product volume (r_s = .71; P < .0001) and number of chambers collected (r_s = .72; P < .0001). CD34⁺ cell yield was better predicted based on (a) product CD34⁺ cell concentration from samples after 2 and 4 chamber flushes, respectively (r_s = .969; P < .0001 and r_s = .9648; P < .0001) than based on (b) CE2 formula (r_s = .8262, P < .0001). Spectra Optia provides good quality PBSC products with stable and predictable yield regardless of starting conditions. CD34⁺ sampling of product after few chamber flushes could be used to predict CD34⁺ yield.     

Measuring body mass index (BMI) in nursing home residents: The usefulness of measurement of arm span

Objective. To study whether arm span can be used as substitute for measurement of height in nursing home patients for calculating body mass index (BMI). Design. Explanatory observational study. Setting. Assessment of 35 nursing home residents admitted to long-term stay in a nursing home. Main outcome measures. Correlation between measured height and arm span and of BMI based on both measures. Results. Measured height and arm span, and BMI calculated from either measure were significantly correlated, r_s=0.75, p <0.001 and r_s=0.89, p <0.001, respectively. The ratios of measured height and arm span and between BMIs based on height or arm span are close to 1, but the dispersion is rather large. Conclusion. Arm span is a reliable substitute for measurement of height in nursing home patients. In persons with severe height reduction, arm-span-based BMI is probably more accurate than conventional height-based BMI.     

Oral meal intake as a prognostic predictor of community-acquired pneumonia: A retrospective cohort study

IntroductionThe association between oral intake volume and prognosis has not been studied in hospitalized patients with community-acquired pneumonia (CAP).MethodsWe retrospectively examined 503 hospitalized CAP patients to evaluate whether early-phase meal intake (EMI) (within the first 24 h after hospitalization) and maximum meal intake (MMI) (on the day during hospitalization) are useful prognostic predictors.ResultsOf the 503 patients, 40 (8.0%) died within 30 days. Area under the curve (AUC) for prognosis was comparable between EMI, A-DROP, and serum albumin [EMI: 0.80, 95% confidence interval (CI) 0.75–0.84; A-DROP: 0.77, 95% CI 0.71–0.83; Serum albumin: 0.72, 95% CI 0.64–0.79]. Mortality rate was <1% in patients with EMI ≥ 50%. Univariate analysis showed that patients with EMI < 50% showed poor prognosis [odds ratio 53.4, 95% CI 7.2–392.2]. Multivariate analysis showed that EMI was an independent prognostic predictor [odds ratio 23.6, 95% CI 3.11–179.7]. AUC of MMI for prognosis was 0.94 (95% CI 0.91–0.96); mortality rate was <1% for patients who ingested ≥50% of meals on any day during hospitalization. We defined ingesting ≥50% of meals on any day during hospitalization as oral intake stability. Multivariate analyses revealed an association between oral intake stability and prognosis. Odds ratio of oral intake stability for prognosis was higher than that of conventional evaluations (vital sign and CRP level stability). Fewer days were required to reach oral intake stability than to reach vital sign and CRP level stability.ConclusionsOral intake is a simple, non-invasive, cost-free, and powerful prognostic predictor for patients with CAP.